Closure of the second toe transfer donor site without disruption of the deep transverse metatarsal ligament

The second metatarsal is routinely excised to facilitate closure of the defect created by the harvest of a second toe transfer. However, if the deep transverse metatarsal ligament is not disrupted by the harvest, it seems unnecessarily destructive to remove the metatarsal. A small arterialized venous flap provides a logical solution to the problem of wound closure in this circumstance. This paper describes such a reconstruction, discusses the reasons for its selection and the long term outcome, which has been very satisfactory.